Saturday, November 15, 2008

Ambulatory Surgery Centers

The two biggest issues I run into on surgery centers are:
1) Coordination between equipment and infrastructure needs.
2) User-initiated changes during the procurement process.

There are a lot of things going on in the walls and ceiling of a surgery project. Duct work, medical gases, electrical, plumbing, cable trays, etc. Trying to install the medical equipment can be an arduous process in itself. When you discover a coordination issue such as a missing electrical outlet, missing back flow prevention device, or an item that required either dedicated or emergency power; that cramped space in the walls and ceiling can make resolution a real headache. And having user-generated changes can really throw a wrench into the works.

Here is a sequence of photos showing the ceiling of an OR being installed over the span of 5 weeks. Image how much easier it is to make a change in the ceiling during week 1 than in week 5.

Week 1

Week 2

Week 3

Week 5

While it is frustrating for the architect, engineers and contractor to have changes to the manufacturer and model of the medical equipment, it is important to understand that medical equipment technology changes rapidly. The devices that were specified in the year or two ago since design development have likely been replaced by newer and better offerings. If you’re project is in California, design development might have been 3 or 4 years ago. Change happens.

The best solution is to closely monitor these issues. Be diligent. Involve your equipment planner in the plan review process. I find that too often, the engineers are designing the electrical, plumbing and mechanical for equipment that they do not understand. It is always beneficial to have the equipment planner, or the vendor do a plan review to make sure all the requirements are shown on the plans. A purchasing agent, materials manager, or clinician is NOT going to have the expertise or comfort level to do a plan review. Be sure to use someone knowledgeable about both the equipment and reading architectural plans - especially the mechanical, electrical and plumbing.

Next, be proactive. Request that someone from the project team be on the list to review all PO’s before approval. They don’t need the authority to approve or reject anything, but they should offer input on any cost impact for making each purchase.

Here are a few examples:

OR lights

Each manufacturer has a slightly different approach to power. Some have a remote power transformer that mounts above the ceiling. Some have a remote power transformer that can be installed in the room within casework or on a shelf. A few offer units integrated into their wall mounted dimmer control. So a change from vendor A to vendor B will impact conduit runs and electrical locations.

Medical gas connections

Typically the mechanical contractor will supply the medical gas wall outlets, if a head wall system is used, the facility may purchase it. In either situation, the gas flow meters and suction regulators are almost always purchased from a different vendor. Making certain that the connection types match is a simple, yet too often they are missed as part of the coordination process.

Under counter appliances

Three letters, ADA, have made under counter dishwashers, refrigerators and ice makers a coordination headache. Because of the lower counter heights in ADA compatible areas, the space tolerances for these appliances are minimal. A waterfall edge on a counter or the thickness of carpet can be the difference between a tight fit and no fit at all.

The cost of this coordination is minuscule compared to the cost of the potential change orders that can be avoided. In this endeavor, timing is everything. When the project team knows about a change with enough time to add the outlet, move the conduit, or pull the right wire, the project saves substantial cost. If these changes are noticed on installation day, when the walls are painted and everything is trimmed out, the cost goes up significantly.

Imagine the time and effort to try and work in these spaces to make changes or add new services:

Conduit and Duct Work:

Med Gasses and duck work:

Cable tray, Duct work and Fire sprinklers:

Cryogen Vent and Duct Work

Equipment planners define budgets and equipment requirements in the design stages of a project. Make certain that you involve them all the way through to occupancy to avoid the perils of equipment–related change orders. Keeping your project on schedule and on budget is always easier when you have information in a timely manner and the opportunity to make educated decisions.

No comments: